chapter 25 respiratory conditions. effect of aging on the respiratory system reduction in vital...

Chapter 25Respiratory Conditions

Chapter 25Respiratory Conditions

Effect of Aging on the Respiratory SystemEffect of Aging on the Respiratory System

• Reduction in vital capacity and an increase in residual volume

– Less air exchange and more air and secretions remaining in the lungs.

• Drier mucous

• Lung abscesses, infections, and the aspiration of tooth fragments.

• Relaxed sphincters and slower gastric motility  

Measures to Improve Indoor Air Measures to Improve Indoor Air

• Install air filters in heating and air conditioning systems.

• Vacuum regularly.

• Damp-dust furnishings.

• Discourage cigarette smoking.

• Open windows to air out rooms.

• Maintain green houseplants to help detoxify the air.

Facilitating Respiratory HealthFacilitating Respiratory Health

• Include measures to prevent respiratory infections in every care plan.

• Promote deep breathing exercises

• Avoid smoking

• Avoid immobility

• Advise older adults not to treat symptoms of respiratory infection independently

Facilitating Respiratory Health (cont.)Facilitating Respiratory Health (cont.)

• Discuss the impact of drugs on respiration

• Review environmental factors that can influence respiratory health.

• Promote health of the oral cavity.

AsthmaAsthma

• Can be a lifelong problem or develop in old age.

• Can create cardiac problems due to the extra stress it places on the heart.

• Elders need to identify causative and contributing factors and aid in their reduction.

• Risks with sympathomimetic bronchodilating nebulizers should be explained to elders.

Symptoms of Chronic BronchitisSymptoms of Chronic Bronchitis

• Persistent, productive cough

• Wheezing

• Recurrent respiratory infections

• Shortness of breath

Management of Chronic BronchitisManagement of Chronic Bronchitis

• Remove bronchial secretions and prevent obstruction of the airway

– Maintain good fluid intake and expectorate secretions.

• Avoid chronic respiratory irritation

– E.g., smoking.

• Help older adults prevent respiratory infections

Factors Contributing to EmphysemaFactors Contributing to Emphysema

• Chronic bronchitis

• Chronic irritation from dusts or certain air pollutants

• Morphologic changes in the lungs

– Distention of the alveolar sacs, rupture of the alveolar walls, and destruction of the alveolar capillary bed

• Cigarette smoking

Symptoms of EmphysemaSymptoms of Emphysema

• Symptoms are slow in onset; may cause delayed treatment.

– Increased dyspnea not relieved by sitting upright.

– Chronic cough

– Hypoxia, fatigue, anorexia, weight loss, and weakness

– Recurrent respiratory infections

– Malnutrition, congestive heart failure, and cardiac arrhythmias

Measures to Treat EmphysemaMeasures to Treat Emphysema

• Postural drainage

• Bronchodilators

• Avoidance of stressful situations

• Breathing exercises

• Stopping cigarette smoking

Factors Contributing to the Development of Lung CancerFactors Contributing to the Development of Lung Cancer

• Chronic exposure to:

– Cigarette smoke

– Asbestos

– Coal gas

– Radioactive dusts

– Chromates

Symptoms of Lung CancerSymptoms of Lung Cancer

• Dyspnea

• Coughing

• Chest pain

• Fatigue

• Anorexia

• Wheezing

• Recurrent upper respiratory infections

Diagnosis and Treatment of Lung CancerDiagnosis and Treatment of Lung Cancer

• Diagnosis:

– Confirmed through chest roentgenogram, sputum cytology, bronchoscopy, and biopsy.

• Treatment:

– Surgery

– Chemotherapy

– Radiotherapy

Causes of Lung AbscessCauses of Lung Abscess

• Pneumonia

• Tuberculosis

• A malignancy

• Trauma to the lung

• Aspiration of foreign material

Symptoms of Lung AbscessSymptoms of Lung Abscess

• Anorexia

• Weight loss

• Fatigue

• Temperature elevation

• Chronic cough

• Sputum production may occur, but this is not always demonstrated in older persons.

Preventing Respiratory ComplicationsPreventing Respiratory Complications

• Assess vital signs.

• Use oxygen safely.

– Keep flow at prescribed level.

– Prevent kinking or blockage of tube.

• Use modified procedure for postural drainage for older adults.

• Use measures to promote removal of secretions.

Nursing ObservationsNursing Observations

• Respiratory rate and volume

• Pulse

• Blood pressure

• Temperature

• Neck veins

• Patency of airway

Nursing Observations (cont.)Nursing Observations (cont.)

• Coughing (frequency, depth, productiveness)

• Quality of secretions

• Mental status

Complimentary TherapiesComplimentary Therapies

• Herbs with mucus-secreting effects and expectorant effects

• Aromatherapy with eucalyptus, pine, and lavender

• Hot, spicy foods to open air passages

• Dietary supplements including zinc, proteolytic enzymes, and vitamins A, C, E, and B6

• Acupuncture and acupressure

• Yoga

Promoting Self-CarePromoting Self-Care

• Assess patient’s ability to use nebulizers properly.

• Assess the ability of caregivers in other settings to properly provide care.

• Encourage older adults to obtain pneumococcal and influenza vaccines.

• Be aware of the psychosocial implications of respiratory conditions.

SourceSource

Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).